The Clinical Coding Specialist is responsible for handling risk adjustment related activities to ensure that CMS coding and documentation guidelines are met and members risk scores are accurately reflected.This position will assist in developing strategies to improve risk score performance through collaborations with health plans and providers. The responsibilities include performing chart reviews to identify coding opportunities, participate in training seminars, physician education, perform internal chart audits to ensure preparedness for potential RADV audits, and other projects as assigned.
Perform ongoing chart reviews of targeted physician offices in a timely manner for HCC data extraction to meet CMS sweep deadlines
Perform ongoing chart audits of targeted physician offices to ensure HCC data is validated in preparation for health plan internal audits and/or CMS RADV audits.
Responsible for the data collection of medical records as requested by the plans for chart audit/review purposes
Responsible for preparing chart audit findings and communicating this back to physicians in timely manner
Responsible for presenting chart audit findings as well as physician performance trends to management
Develop physician group training utilizing data and findings from chart reviews to help ensure proper documentation elements are in place
Provide risk adjustment in-services to physician offices as needed
Responsible for the development of content for monthly fax blast, quarterly provider newsletter, and website
Assist in developing strategic initiatives related to HCC score improvement for physician and IPA
Responsible for the development of risk adjustment tools as needed and/or as requested by physician offices
Annual update ofPCP and Specialist superbills
Perform audits of HCC patient data as reported by health plans for purposes of reconciliation of payment
Participate in tele-conferences and off site conferences as needed to be informed of current CMS requirements
Provide training to appropriate internal staff related to HCC documentation and coding
Perform other assigned duties / special projects on an as-needed basis.
Foster positive interaction and relationships with all internal departments as well as cultivating positive working relationships with external contacts.
Prefer 1 year of healthcare coding experience
Current Certified Professional Coder license or higher equivalent
Strong verbal and written communication skills
Strong knowledge of CMS Risk Adjustment requirements
Strong team player
Strong computer skills
Ability to travel locally.
Requires comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and privacy of protected patient information.
Required: AA Degree Preferred: Bachelors degree
Required: 5 years coding experience
Required: RHIA, RHIT, CCS, COC, CPC or COC
Job: Medical Coding
Primary Location: Cypress, California
Facility: Coast Healthcare
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2005007986
About Coast Healthcare
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.